It’s been 14 years since the Institute of Medicine recommended that nurses not work more than 12 hours within 24 hours.

It’s been 8 years since the Joint Commission issued a sentinel event alert based on the evidence that connected extended work hours, fatigue and decreased patient and worker safety.

It’s been 4 years since Elizabeth Jasper was killed driving home after a 12 hour shift and Editor-in-Chief Maureen Shawn Kennedy wrote an editorial in the AJN pointing out that “Best practices” should also cover the health and safety of those who practice.”

What’s changed? If you listen to the voices of thousands of nurses on the front line, the answer is “Nothing – in fact, it’s gotten worse”. What is staffing like where you work? And how do you normally cope with short staffing situations?
Negative repercussions can be very subtle. One example would be the manager telling you that she can’t approve your time off (when she/he had previously agreed.) It’s difficult, but important, to still act professionally in all of these situations and to find common ground. One nurse approached her manager and began the conversation by saying, “I know you care about the patients and nurses here as much as I do….”

Do you ever feel retaliated against for standing up for safe staffing? Here is a list of some things you can do because so often we feel hopeless and underestimate our power:
• Make a report to the Joint Commission patientsafetyreport@jointcommission.org
• Never skip a meal or break – call your manager or house supervisor to step in for you and then keep going up the chain of command. File a missed break/meal report.
• Don’t feel responsible for your organizations failure to hire an adequate number of nurses – travelers, temporary nurses and a float pool are options they know they have
• Advocate for a resource pool to your Board of Directors by using specific examples from your daily practice of how unsafe staffing effected both nurse and patient safety
• Contribute money to your state’s Nursing Political Action Committee
• Stay connected to your 675,000 peers in Show Me Your Stethoscope!

But remember, the day that the profession of nursing is respected will be when nurses have the power to decide for themselves how many nurses they need. And that day is long overdue.

This is the first guest blog in a series by Kathleen Bartholomew, author of The Dauntless Nurse. Don’t forget to read her second post in the series “It all comes back to staffing“

There -are now 28 states that have approved the use of medical marijuana – and 8 states recreationally. So chances are strong that some nurses are using marijuana for medical reasons, or for recreation. But how much is too much?

One joint in the 1970’s has the same potency of one puff today. Since 1998 the potency of marijuana has doubled. But what if you smoke a few hours before your shift? Edibles can take a few hours to feel the effects – and if you smoke it can take three hours or more to get out of your system. Having a medical-use card does not give nurses sufficient protection, as discussed this Medscape article.

Nurse Mary has lupus and a medical marijuana card. She also wants to make sure she is safe taking care of her patients; and that her license is safe. The laws don’t prohibit use unless it impairs practice, but employers can still take action. So both of these areas are still gray zones as marijuana is not supported federally, there is no consensus on toxicity level, and a hospital can decide independently to fire someone who tests positive whether they have a card or not. In Washington State for example, driving under the influence of marijuana is similar to driving drunk: 0.8 for alcohol – or 5ng/ml THC. But do you know your THC level when you arrive at work?

“If you consistently notice any of the problems listed below in a peer, it is your ethical obligation to compassionately go to your peer, and share your concerns. Our primary obligation as nurses is to protect our patients, but we should also care for each other. A large percentage of nurses are over the age of 45, so some of the symptoms below may be related to menopause! We shouldn’t jump to conclusions or make judgments, but most importantly we can’t ignore impaired nurses.

How would you handle a situation with a nurse that appeared to be impaired?

What would you do if a nurse had symptoms of being impaired by marijuana such as: